NVNA and Hospice Case Study

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NVNA and Hospice Decreases Readmissions, Improves Patient Satisfaction with Telehealth and RPM

NVNA and Hospice delivers high-quality care in the comforting environment of a patient’s home. In 2020, NVNA and Hospice celebrated 100 years of providing quality, certified home and hospice healthcare to communities across eastern Massachusetts (MA) and earned five stars in patient satisfaction


In February 2020, Massachusetts recorded its first case of COVID-19. By mid-April, the state was averaging nearly 2,500 new cases per day. The rapid spread of COVID-19 and intensive care required for treatment placed strains on healthcare agencies already confronting numerous challenges including:


Significant workload and staffing challenges caused by a growing patient census and increasingly vulnerable patients

Growth Chart

Rising hospital readmissions and ED visits spurred by an increase in chronic illnesses to over 4 million MA residents

Revenue Chart

Ballooning cost of care while adjusting to new PDGM regulations and quality metrics during a pandemic


In 2018, NVNA and Hospice partnered with Health Recovery Solutions to expand their longstanding telehealth program. The program goals were to reduce hospital readmissions and to cut the cost of care. Initially, the most at-risk patients were enrolled in the program, which provided 24/7 clinical support.

At the onset of the COVID-19 pandemic—while confronting new and difficult challenges—NVNA and Hospice rapidly expanded their telehealth program, broadening patient eligibility, leveraging mobile solutions, and increasing utilization of virtual visits.

3 Ways HRS Helped Expand the Telehealth Program:

  • Enhanced the clinical efficiency and communication between referring physicians and patients; patients reported daily metrics and clinicians could analyze trend reports, relieving the workload placed on field clinicians and reducing staff burden
  • Established COVID-19 protocol for at-risk populations, incorporating patient educational resources and custom risk alerts provided through RPM to prevent hospitalizations
  • Augmented in-home visits with HIPAA-compliant virtual visits, protecting clinical staff, maintaining PPE supplies, and reducing average cost of care and unexpected expenses
The ability to provide clinical virtual support and rapid multidisciplinary oversight to our patients was critical to our success during this COVID19 pandemic

— Cheryl Meyer Nelson, PT,MPH, GHC, CDP
Clinical Manager TelemedicineDepartment

2020 Average 30-Day Hospital Readmission Rate for Telehealth Population

2020 Average Telehealth Monthly Patient Census

Virtual Visits Performed During 2020


Throughout 2020, while facing extensive industry challenges and a global pandemic, NVNA and Hospice maintained an average 30-day hospital readmission rate of 5% across NVNA’s telehealth population.

While drastically expanding the number of patient populations enrolled in the telehealth program, NVNA and Hospice received average patient satisfaction scores over 93%, with 90% of patients stating that they are more involved in their own healthcare as a result of the telehealth program.

How Telehealth and RPM Supports Family Caregivers

During the COVID-19 pandemic, Sue was admitted to the hospital with a urinary tract infection (UTI) and was later diagnosed with COVID-19. Upon discharge from a rehab facility, Sue was admitted to NVNA and Hospice and enrolled in the telehealth and RPM program following a virtual preadmission Wellness Call.

During the virtual preadmission Wellness Call, NVNA and Hospice evaluated the patient, assessed the family’s risk of exposure, and determined the caregiver’s ability and comfort level in supporting the patient while recovering.

Leveraging HRS’ PatientConnect Mobile, NVNA and Hospice was able to immediately enroll Sue in the telehealth program to begin monitoring her conditions, and was able to provide her with virtual access the same night she was admitted to home health.

Over the last few years, Sue has been admitted to the hospital numerous times due to UTIs and other illnesses which were unrecognized by her family caregivers. NVNA and Hospice provides an additional layer of support to Sue and her caregivers by helping Sue monitor her medication compliance, symptoms, and vital signs each day.

Both Sue and her husband have used the telehealth platform to expand their knowledge and understanding of Sue’s conditions and to improve their engagement in her care. Through telehealth, Sue and her husband have learned how to avoid symptom flare-ups and have established new routines to ensure Sue’s ongoing health and wellbeing

It is very comforting to know that there are people keeping a close eye on my mom’s health... Having her home during the pandemic has played a vital role in reducing my family’s level of stress. Knowing that she is home [and] getting the care she needs is very comforting for all of us.

— Tara S.
Sue’s Family Caregiver